Paralyzed Veterans of America Testifies on Improving VA Adjudication of Complex Disability Claims

Sherman Gillums Jr. Congressional Testimony December 4, 2013
Associate Executive Director of Veterans Benefits for Paralyzed Veterans Sherman Gillums, Jr., testifies Dec. 4, 2013, before a House subcommittee on complex disability claims. View full testimony below.
On December 4, 2013, Paralyzed Veterans of America testified before a House subcommittee on complex disability claims offered improvements the Department of Veterans Affairs (VA) must make to evaluate claims involving severe disabilities more effectively. 

Sherman Gillums, Jr., associate executive director of veterans benefits at Paralyzed Veterans of America, testified that while the VA has made progress in reducing the number of backlogged disability claims through the use of new technologies and innovative processes, it is now time for the department to shift its focus on adjudicating complex claims, including those related to spinal cord injury or disease or terminal illnesses such as amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s Disease, more effectively.

“With all the attention focused on VA’s new initiatives that have helped reduce the overall number of claims stuck in the queue, the challenges faced by the most vulnerable veterans – those who are severely disabled and terminally ill – has received little attention over the last few years,” Gillums said. “But these are the veterans for whom Paralyzed Veterans gives voice, and this hearing allowed us to remind Congress and VA that all veterans deserve to have their claims timely and accurately adjudicated.”

More specifically, the VA’s new rules-based processing model for disability compensation claims – the Veterans Benefits Management System (VBMS) – was rolled out in an effort to expedite claims, yet the challenge with such a rules-based system is that it lacks the human intuition and reasoning necessary to fully understand the circumstances of a specific injury.

The increase in the number and complexity of disability claims has risen in the last decade for several reasons. More service members have survived battlefield injuries once considered fatal thanks to advances in medicine and training for first responders. Also, modernized armor and gear for troops hit by gunfire and improved explosive devices has increased the likelihood of survival for those who are severely wounded, resulting in complicated physical disability pictures compounded by invisible disabilities such as traumatic brain injury (TBI), post traumatic stress (PTSD), and in some cases military sexual trauma.

“Experienced raters, not algorithms, best factor in the nuances of special monthly compensation and areas of subjective interpretation that can lead to an incorrect decision,” Gillums said. “For this reason, reducing the backlog through the use of technologies cannot come at the expense of accurately rating the most complicated claims in the inventory.”

There are several areas where VA can improve support to veterans needing specialized medical care, including assigning such cases only to the most experienced raters and ensuring new raters are appropriately trained on these issues. VA also needs to allow for a "common sense" override when rules-based processes limit or preclude necessary subjective analysis, and expand the acceptable clinical evidence directive for nationwide implementation, Gillums told the subcommittee.

Paralyzed Veterans also believes that if a complex claim is denied based on a Compensation and Pension exam – which often are overused by the VA even when evidence of record already substantiates a claim – the reasons and bases for denial of the claim must detail how the weight of all evidence was assigned, including whether reasonable doubt was applied. VA also must ensure the “reasonable doubt doctrine” defined by federal law is applied throughout the rules-based process. 

“We fear that as VA continues to aggressively look to reduce the backlog, complex claims may get oversimplified and underrated for the sake of hitting quotas,” Gillums said. “But this is not a numbers game for us. The only acceptable outcomes are decisions that give maximum benefits to claimants in a timely manner, especially those veterans who have suffered the most serious injuries and conditions imaginable.”

Read Paralyzed Veterans of America's full Congressional testimony from Dec. 4, 2013 

Learn more about Paralyzed Veterans of America’s Veterans Benefits Department

Brittany Ballenstedt is a freelance journalist whose work has appeared in several publications, including Government Executive, National Journal, Technology Daily and NextGov.com.  

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